ATLANTA — House Speaker David Ralston has broadly endorsed the idea of extending a high-profile hospital industry tax that generates a sizable portion of revenue for state health care.

In a separate matter, the Blue Ridge Republican promised during a wide-ranging interview Thursday that he will push for changes to Georgia’s ethics law, including broadening the definition of who qualifies as a lobbyist to bring more people under rules that govern interactions with elected officials.

The so-called “bed tax” and lobbying law promise to be major themes of the General Assembly’s annual session that opens Monday.

Ralston said he wants his colleagues to give “very serious thought” to continuing the tax in some manner, echoing forecasts from Georgia Hospital Association leaders that failure to do so will force several hospitals around the state to close. The Medicaid financing idea involves assessing hospitals, using that money to secure federal support, then plowing the entire pot of money — more than $650 million this year — back into Medicaid payments to health care providers.

The speaker dismissed outside political pressure, led by national GOP powerbroker and anti-government activist Grover Norquist, not to renew the measure. Some lawmakers, particularly Republicans, fear re-election campaigns in which they could be branded as tax-and-spend politicians. The speaker went so far as to argue the current arrangement isn’t a tax at all: “It’s an assessment that allows us to draw down our money that we sent to Washington.”

Those who vote to extend it certainly wouldn’t be supporting a tax increase, the speaker added.

“Anyone who says that is being dishonest,” Ralston said. “I would hope we could put aside what might be on the (campaign) mail pieces and look at the facts. ... Young children depend on this.”

Legislators adopted the hospital tax — it’s actually an assessment on patient revenues — in 2010 to help make up for lagging revenues blamed on the recession. Each Georgia hospital pays a 1.45 assessment on their net patient revenue. That increases Georgia’s contribution to Medicaid, a joint state-federal program in which the federal government matches local spending at varying rates based on factors like a state’s per-capita income. The money yields an 11.88 percent Medicaid rate boost for hospitals.

Georgia hospital leaders have submitted to Gov. Nathan Deal and lawmakers a proposal to extend the current assessment and then add a second fee, to be paid by certain private hospitals that lose money on the initial levy because they don’t treat many Medicaid recipients. Like the patient-revenue tax, the secondary assessments would be used to get more federal money. But that second pot would be used for payments targeted back to the private hospitals, mitigating their losses from the overall concept.

Ralston said specific Medicaid finance legislation is still being drafted. He did not say whether it would exactly reflect the industry proposal, nor did he identify a sponsor.

Republicans will introduce legislation next week seeking to tighten the rules governing who must register as a lobbyist and disclose their spending on politicians. Under current law, those seeking to influence Statehouse lawmakers must register if they spend more than 10 percent of their monthly working hours on lobbying. They must also register if they spend $1,000 or more annually to lobby.

“We’ve got a lot of people running around this capitol that should be registered lobbyists wearing badges because they’re advocating for one side of an issue or another, and they’re not registered,” Ralston said. He would not discuss what specific steps may be taken to tighten those requirements.

That statement marks another development in Ralston’s public views on the issue. In the past, he had defended Georgia’s system that forces lobbyists to disclose — though it does not limit — what they can spend to influence legislators. Ralston had said voters could decide whether a politician was acting egregiously, and he said setting firm limits on lobbyist spending would drive that activity underground.

His stance shifted this summer after 81 percent of Georgia voters, or more than 1 million people, voted in favor of limiting lobbyists’ spending in separate nonbinding ballot questions in the Republican and Democratic primary elections. He opposes a Senate proposal that would generally cap lobbyist gifts at $100. The Senate may vote on adopting that limit as an internal chamber rule as soon as Monday.

“I don’t know how you can tell the people of Georgia that it’s real reform when you can spend 99 dollars on them but not a hundred-and-one,” Ralston said, referring to the Senate’s $100 cap.

The chairman of the House Ethics Committee, Rep. Joe Wilkinson, R-Atlanta, said he was trying to create a system that would achieve the ban sought by Ralston without making some things illegal, such as preventing a statewide parent teacher association from paying for a luncheon with the entire General Assembly.

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